To the Editor Samsky et al1 compared the trends in readmissions for patients hospitalized with heart failure in Canada and the United States, but substantial differences between the cohorts from the 2 countries call into question the validity of their conclusion. The cohort from the United States included patients who were younger than 65 years and enrolled in Medicare owing to disability or end-stage renal disease—a distinct group of younger patients who accounted for about 10% of the cohort. The Canadian cohort also included patients who were younger than 65 years but who, unlike their counterparts in the United States, were in general healthier than the older patients and accounted for about 15% of the cohort. The readmission rate for the younger group from Canada was more than 3% lower than that of the older patients in the cohort (15.6% vs 18.7%), while the readmission rate for the younger patients in the United States was about 2.5% higher than that of the older patients in the cohort (22.1% vs 19.6%). Although the authors conducted a sensitivity analysis restricted to patients 65 years and older, it was limited to the association of length of stay with 30-day readmissions. No sensitivity analysis results were reported on trends of readmission, which is the focus of the article.
Lin Z, Li S. Substantial Differences Between Cohorts of Patients Hospitalized With Heart Failure in Canada and the United States. JAMA Cardiol. 2019;4(11):1178–1179. doi:10.1001/jamacardio.2019.3314
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